Project Summary - Demand, Cost, and Access of Radiotherapy in VA, Fee, & Non-VA Facilities Project Background: Radiotherapy is a treatment provided by the Veterans Health Administration (VA) to patients as a result of the diagnosis of certain cancers. Radiotherapy services may be provided directly by the VA, or payment for these services may be made to non-VA providers in the community under certain circumstances (fee-basis or contracted care in non-VA sites). Additionally, veterans that are dually eligible (e.g., VA and Medicare) may also choose to receive care at non-VA facilities that is paid for by the Medicare program. Veterans (independent of age) may also carry private insurance, though care received in such circumstances is difficult for the VA to track. Circumstances that may necessitate the use of the VA-fee basis program include when VA facilities are not capable of furnishing economical hospital care or medical services because of geographic inaccessibility, or are not capable of furnishing the care or services required. Because radiotherapy is a limited resource within the VA's health care system, nationally, much of this care is purchased by the VA from community resources. Preliminary cost and utilization data demonstrate considerable growth in the demand and expenditures for radiotherapy services provided under VA auspices over the past 8 years. The current economic downturn, expansion of benefits to veterans (e.g., categories 6, 7, 8), and Medicare payment reductions for radiotherapy have raised access and capacity concerns of VA radiotherapy. In turn these are important planning questions for the VA national purchased care (VA Fee) director, Patricia J. Gheen and the VA national director radiation oncology led by Dr. Michael P. Hagan, both of whom are key advisors on this study. Project Objectives: 1) Identify trends (2000 to 2008) in the fiscal year-specific use and expenditures in radiotherapy services across the VA that are provided in VA (salaried and contracted) and Non-VA (Fee Basis and Medicare) facilities. 2) Identify and track over time the proportion and magnitude of radiotherapy services for VA enrolled veterans that is paid for by the Medicare program when the veteran is dually eligible. 3) Determine if patient access to VA care is associated with the location of radiation treatment delivery when the veteran is dually eligible. 4) Forecast future needs for VA and Non-VA (Fee Basis) care for radiotherapy services after accounting for the potential influx of Medicare dually enrolled veterans. Project Methods: We will identify major sources of variation in the demand and expenditures for radiotherapy clinical services at the system level with a special emphasis on radiotherapy services provided by non-VA providers (Medicare and VA-Fee). We propose to trend at least 9 years of data (FY 2000-2008). We shall use quantitative methods common to epidemiology and economics to examine volumes of radiotherapy services provided, and geographic variation.